An Episcopal (Anglican) Chaplain in the Saint Luke's Health System of Kansas City, reflecting on work and faith and life. NOTA BENE: my opinions are my own and do not represent the Episcopal Church or the Saint Luke's Health System.

Saturday, January 14, 2017

Some of you may wonder why I haven't said too much about the threats to adequate healthcare for all Americans. Some of you may wonder why I have said "keep healthcare stable," instead of just defending the Affordable Care Act. I have done that because I actually work in healthcare, and want to be clear, including by when and where I'm logged in, that these are my opinions and not a reflection of or a reflection on my employer.

That said (and I can't imagine anyone will be surprised), I do have opinions. First and foremost, I think we have sold the Act incorrectly. The name of the act that is labeled Obamacare is "The Patient Protection and Affordable Care Act." We've spent so much time letting folks complain about what "affordable" might mean, and for whom, that we are now at risk for letting the "protection" get washed away. Pay close attention: it is the protections that are truly popular - no exclusions for pre-existing conditions; equity on preventive care for both men and women; equity for mental health with physical health; subsidies to allow the most vulnerable to afford insurance; insurability for folks whose employment and lack of income had left them out; coverage for children on a parent's policy until age 26; a set of minimum standards for what a policy should provide. It is also the protections that make this less "affordable;" and so it is the protections that are at risk. So, not just "Defend the ACA;" "Defend the Patient Protection Act."

So, I speak about "keep healthcare stable" because I can imagine improvements to the Patient Protection and Affordable Care Act; and even a replacement that might be better. At that point, I heard Paul Simon singing about "the myth of fingerprints:" I don't care much whose name is on the bill as long as the bill does the right things. Call it Romneycare instead. Call it the German Model, because this is basically how the Germans meet everyone's needs. Call it Trumpcare or Ryancare - I don't care, as long as it's a real replacement - you know, one that does at least what the old one did (EVERYTHING the old one did), and perhaps more, and perhaps more economically. One of our major auto insurance companies has this ad out, with a focus on their full replacement policy. The hook, proclaimed by the actor complaining about another company is, "Do they expect you to drive 3/4 of a car?" So, I am interested in stability more than the myth of fingerprints. I don't care whose name is one it; but 3/4 of a replacement for the Patient Protection and Affordable Care Act is not a true replacement.

I am also concerned about stability because healthcare is one of the largest employers, as a sector of the economy. These are good jobs, professional jobs, that can't be outsourced overseas. In my years in the business one of its hallmarks has been the many people who have started at the bottom and used employer-supported resources to have better jobs and better pay. One of the patient protections at risk if things aren't stable is an adequate workforce to care for them. Note that at this point I'm not talking about chaplains. We are so small a part of the industry already that we can't sway much. I'm talking about nurses, therapists, lab scientists, and pharmacists. To have them when we need them means we need to keep healthcare stable.

So, there I am: I'm willing to hear that there's a better way; but those who claim that need to actually offer something better. They need to offer it clearly, and they need to offer it before dismantling what is in place. For patient protection, affordability, and a stable economy - things that have actually been helped by the Patient Protection and Affordable Care Act - we need to keep healthcare stable.